By Dr. Jim Rimmer
There is a critical need for sustainable and effective approaches that will improve health and function in people with disabilities who are experiencing a high prevalence of secondary conditions affecting their overall health status and quality of life. Data from the classic paper published by Susan Kinne and her colleagues1 in 2004 in the American Journal of Public Health (see table) found that every secondary and associated health condition reported by people with and without disability in the state of Washington was higher in the group with disability. These secondary conditions can alter the course of health in people with disabilities. Conditions such as pain, fatigue, weight gain and deconditioning – all effectively treated with exercise – have a compounding effect on reducing health and function. For example, physically demanding tasks such as pushing a wheelchair or walking with an assistive aid will become more and more challenging in individuals who are physically inactive and have a slow but steady decline in strength, balance and cardiorespiratory reserve. Sitting for long periods of the day has also been shown to create significant health risks. New research is substantiating the negative health effects associated with long bouts of sitting, which include increased risk of heart disease, stroke and diabetes. The importance of more standing behavior throughout the day (especially among people with lower extremity paralysis using standing boards, wheelchairs that allow for standing and other devices) should be conveyed by health care professionals to people with disabilities.
|Rate of Secondary Conditions in Adults with and without Disability (Kinne et al. 2004)|
|Condition||Rate in Total Sample, % (n=2075)||Rate in Disability Group, % (n=545)||Rate in No Disability Group, % (n=1530)|
|Chronic pain in muscles, joints||23.8||55.6||14.2|
|Weight or eating problems||19.8||39||13.7|
|Periods of depression||17.2||33.5||12.1|
|Respiratory infections (not colds)||10.9||20.9||7.8|
|Falls or other injuries||10.2||20.6||6.9|
|Serious episodes of anxiety||9.6||19.9||6.3|
|Lack of romantic relationships||8.4||14.9||6.3|
|Problems getting out/getting around||8.3||22.4||3.9|
|Problems making/seeing friends||7.4||12.7||5.7|
|Feelings of being isolated||5.6||14.8||5.3|
While there is promising research that secondary conditions may be mitigated or prevented through the use of exercise, the effects of different types and amounts of exercise on targeted secondary conditions for specific subgroups remains unknown. Our ability to qualify and quantify specific doses and types of exercise for specific health conditions is in the early stages of inquiry but still lacks a coherent framework. The current literature on exercise and disability is extremely broad in scope and is often too generalized.
People with disabilities, researchers and health and rehabilitation professionals need better and more clearly defined exercise science research that delineates specific types, doses and strategies for establishing a new field of evidence-based exercise for people with disabilities. Interventions that can prevent or delay the onset of secondary conditions and subsequently improve health and function in people with disabilities hold significant promise for optimizing their health, function, participation and quality of life.
- Kinne S, Patrick DL, Doyle DL. Prevalence of secondary conditions among people with disabilities. Am J Public Health. 2004;94:443-445.